Internship training program

Interns guideline

Introduction

The aim of internship training program is to provide a general clinical experience in a setting of supervised clinical responsibility in order that interns acquire the necessary knowledge and skills for the practice of medicine in general and that they develop a proper medical attitudes and ethics in accordance of the teaching of Islam.

Rationale

Internship is a period of transition from medical student to a qualified physician a stage, in which an intern gains more confidence in a patient care, develops professional attitude and applies appropriately knowledge and skills in the practice of medicine.

Objectives

The aim is realized through the following objectives:

A/ Attitudes

At the end of the program an intern must believes in the sanctity of life according to the teachings of Islam.

B/ Knowledge and psychomotor skills

At the end of the program an intern is able to:

• Apply the knowledge of clinical medicine as well as basic science in the total care patients.
• Become a proficient in structured and comprehensive history taking and physical examination.
• Compile, keep and update medical records of patients in order to follow the natural history of ailments.
• Discriminate when requesting and evaluating the result of further investigations in order to enhance diagnostic yield but avoid waste of time and resources.
• Be proficient in the art of writing prescriptions, request form, referrals, etc. This is in order to communicate meaningfully with other members of the health profession.

 The hospital

Interns are expected to familiarize themselves with the hospital of their posting particularly the location of service department, medical records, administrative office, laboratory labs, radiology, and emergency area. They should know the emergency codes such as code blue.

Interns should learn to pay attention to paging system. Interns are expected to know the whereabouts of their seniors and ways to communicate with them in case of emergency.

Duties  and attendance

As a resident trainee an intern is in duty all the time, however for a practical   convenience the department prepares duty rote for emergency duties and a schedule per month. All interns are required to present in the hospital during regular working hours.

Interns should remember that there is nothing like “work to rule” in medical practice. Interns working hours are as long as it requires for them to finish their work and certainly as long as the patients require their attention. Patients can’t be left unattended just because the duty\working hours are over. Interns shouldn’t leave any patient unattended until they have handed over the responsibility to another colleague.

All national holidays are considered working days as per internship program regulation. The following is further details:

A/Working hours...

• Units...                  Male>> 8 am - 4pm    ,,,, Female>> 8am – 4 pm but daily one female intern from each units should stay till 6 o’clock.
• Subspecialty...       Male and female>> 8 am - 6 pm unless released from the subspecialty but never leave before 4 o’clock.
• Weekend round...     Either Friday or Saturday. It will be practical half day round
• *Post Oncall Male interns are allowed to leave at 1 o’clock if they finish their work **

B/ Attendance...

• Sign in >> should attend before 8 o’clock in the morning report (if there is no morning report the sign in will be in the Endoscopy reception).
• Afternoon activity >> auditorium D*
• Sign out >> Endoscopy reception

*the attendance is mandatory & it seriously affect the evaluation

**if the intern is excused from the unit consultant or the subspecialty the senior resident and the chief intern must be informed before leaving.

 C/Oncall duties...

Female interns... (Units)

1.  All should be present 8 am up to 6 o’clock pm

2.  Dividing on call is not allowed and not acceptable, and will monitor closely.

3.  In Tuesday every week Dr.Larbi’s clinic from 1-4pm must be covered by the oncall intern with no delay

Male interns...

1.  Duties according to the schedule.

2.  All should be present from 8am -6 p.m. covering code blue only and their oncall starts from 6 p.m. – 8 a.m.

3.  If 2 interns swap their call they should fill and sign the form and submit it to the chief intern to be signed then they should distribute it to all medical words.

4. If patient will be transferred to another facility, then male intern should accompany the patient

Responsibility…

Routine work:

Apart from writing case records and progress notes, are required to fill up various forms completely and correctly. Interns write admission form, discharge summaries, investigation request forms and progress note. They should therefore familiarize themselves with different forms available in the words.

Interns should learn routine word procedures by observation and may perform under supervision invasive diagnostic\ therapeutic procedures such as:

(NGT insertion, paracentesis abdominis, paracentesis thorasic, bladder catheterization, ABG& lumber puncture)

Interns should attend the unit word round and should present full clinical data during the round and they should also obtain results of radiology and laboratory investigations. The objectives are first to test how well he\she knows his patient’s illness and second to have practice in case presentation. For further details,

A/ Units...

1- Responsibility of your patient...

• Daily patient evaluation (morning, afternoon)
• Writing daily progress note
• Keeping them self updated & aware about all the labs, radiology& all other investigation requested for the patients.
• The interns should cooperate; participate with the residents & shadowing them in arranging & getting results or transferring the patients (as its part of patient care & responsibility).
• Entry of medication or investigations should be done by medical interns, and must be under medical resident supervision.
• Discharge summery & medical report should be done by medical resident. It strictly prohibited to be done by intern & you might repeat the rotation if you do so.

2- Respect & follow the order of the counsultant, senior medical resident as well as junior resident. Participate in the unit activity.

B/ Subspecialty...

•  Maintain contact with resident covering the specialty.
• See consultation with the resident & follow up the patient (not allowed to write in the consultation paper).
• Attend all the OPDs of the subspecialty
• Participate in the activities.
• Attitude & respecting your colleagues is mandatory.

 C/Oncall duties:

• Should Clerk all the patients planned for admission either from OPD or ER
• **Not allowed & not acceptable to admit patient without clerking from the oncall intern or copying the resident admission note. This will be monitored carefully and action will be taken against who do so**
• List the differential diagnosis in descending order beginning with the most likely diagnoses and prepares a problem list.
• Initiate necessary and basic investigation in all such patients  
• Should cooperate with the resident in all aspects of the patient care.
• Entries of the orders should be done by the medical intern oncall and must be supervised by the resident oncall.
• Evaluating the patient who has a complain in the medical word, if the patient is stable and have cold complain, then he should be fully evaluated then reported to the medical oncall in the other hand if the patient is unstable and has a life threatening condition such as shock, cardiac arrest and respiratory distress he should report it immediately to the resident oncall. The interns should attends emergencies with a resident when oncall duties. 
• It’s not allowed & not acceptable not to respond fast to the overhead paging as well as the code blue.
• The areas that would be covered by medical intern oncall are (ER, crash area, all medical words and CCU).
• Hand over the oncall female intern to the oncall male medical intern & the oncall male intern to the intern of the unit.
• **Hand over is about Admissions... Case, MRN and location of the patient. Any critical case in the word...To the responsible unit**
• In the near future there will be a bleep or mobile phone but in the time been communication via overhead paging.
• During weekend oncall as the oncall team is under staffed the cooperation between the interns and residents is a must in all aspects needed.

 Ethics, mannerism and punctuality

• For the first time interns deal with patients as doctors. They should approach their patients with confidence, decorum and dignity.
• Interns should practice proper bedside manners, develop proper attitude and follow established medical ethics.
• Intern should pay a proper regard to their patients’ privacy, desires, requests and believes. They should appreciate that all communications by the patient is confidential.
•  Interns should respect and be cooperative with their colleague (consultant, senior medical resident, junior medical resident, nursing staff and the other interns) 

 Dishonesty and misconduct

Medical interns are as a future physician requires not only the development of medical knowledge and practical skills but also high ethical and moral standards including academic integrity. Medical interns who are found guilty of dishonesty or misconduct after a thorough investigation shall be punished depending on the degree of the violations committed ranging from letter of warning or reprimand or suspension to withdrawal or expulsion from the university.

Academic activity

 Interns are expected to show initiative by participating in the academic programs of the department, units or subspecialty.  They should present cases and participate in discussion in morning report, after noon activity and the word round.

 Leaves

• A maximum of 4 days leave can only be allowed if the unit or subspecialty can manage and there is no shortage. Leave exceeding the allowed number of days must be compensated. Leave must be for emergency reasons only
• You must fill the emergency leave form then it has to be signed by the consultant, senior medical resident, chief intern and intern’s coordinator.
• In case of applying for leave you must change the oncall during the leave time before applying.
• Unauthorized leave will be reported to the Vice Dean for Clinical Affairs.
• In case of illness the intern should report their absence to the senior of the unit / subspecialty and chief intern. A copy of the sick leave report must be submitted to the department when he/she get back.
• Ramadan and hajj holidays are considered working days. 

Monthly schedule...

It will done by the chief intern and approved by the intern’s coordinator & the chairman.

Request accepted only for elective rotation unless there is shortage

Intern sometimes will be pulled out from their unit/subspecialty in case of shortage or absence of interns with no objection.

Evaluation …

Interns performance is assessed continuously during their rotation and at the end of the rotation evaluation form will be filled by the coordinator and signed by the chairman.

Interns who have a grade of fair or poor shall repeat the whole or part of the rotation depending on the agreement of the department. 

Forms...

In the consultant office there is one box that contains:

Pre request for rotating in internal medicine department:

BLS

NB: any violation of the previously stated rules would be taken seriously and the intern responsible would compensate the whole rotation